title: Which is better: a miniaturized percutaneous ventricular assist device or extracorporeal membrane oxygenation for patients with cardiogenic shock?
abstract: The purpose of this study is to compare outcomes associated with the use of Impella and TandemHeart short-term support devices with venoarterial extracorporeal membrane oxygenation (ECMO) therapy for postinfarction- or decompensated cardiomyopathy-related cardiogenic shock. Between January 2006 and September 2011, 79 patients were supported with either an Impella axial flow pump (n = 7) or a TandemHeart centrifugal pump (n = 11), or with ECMO (n = 61) therapy for cardiogenic shock in a single institution. Pertinent variables and postprocedural events were analyzed in this cohort of patients using a prospectively maintained clinical database. The in-hospital mortality, successful weaning from mechanical circulatory support, bridge to long-term destination support device and heart transplantation, and limb complications did not differ between the 2 groups based on intention-to-treat analysis. Age was the only independent predictor for in-hospital survival. In this cohort of patients, short-term support devices and ECMO achieved comparable results. In the modern era of medical cost restraints, ECMO may be more cost effective for patients with postinfarction- or decompensated cardiomyopathy-related cardiogenic shock. Larger randomized trials may be necessary to further elucidate this topic.
authors.affiliation: From the *Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH; †Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX; and ‡National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Themistokles
authors.initials: T
authors.lastname: Chamogeorgakis
authors.forename: Aldo
authors.initials: A
authors.lastname: Rafael
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Shafii
authors.forename: Dave
authors.initials: D
authors.lastname: Nagpal
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pokersnik
authors.forename: Gonzalo V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
mesh_terms: D000367:Age Factors; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000601:surgery*